Name

Email Address

Phone Number

On a scale from 1-5, how proficient are you in the water?

On a scale of 1 -5, how comfortable are you with pool swimming

On a scale of 1 -5, how comfortable are you with open water swimming

On a scale from 1-5, how comfortable are you with wearing a wetsuit

Do you have any injuries that prevent you from swimming better? Do you have any injuries that prevent you from swimming better? Yes No

What are you looking to improve with a coach? (Click all that apply) What are you looking to improve with a coach? (Click all that apply) Feel more comfortable in the water Be injury free Improve overall time Other

Is there anything else you would like us to know?